Abstract
The combination of mitral regurgitation and coronary artery disease presents a most significant challenge to the cardiac surgeon. Over the years this entity has the highest operative risk of any of the commonplace, acquired cardiac lesions treated surgically. Previous results from our clinic and others have documented relatively high operative mortality rates due to the urgency of the presentation, the extremely precarious myocardial function, severe triple-vessel coronary disease and prolonged operative insult, or a combination of all four of these factors [3,7, 8,10,14, 16, 18]. Superimposed on a scenario of congestive failure due to severe valvular regurgitation is an often compromised ventricle derived from factors normally related to mitral regurgitation. In addition, the lack of deliverance of appropriate blood supply to these areas may be further complicated by a previous myocardial infarction and scarring. Many reported series have indicated an operative risk of 12–20% using valve replacement alone.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Angell WW, Oury JH, Shah P (1987) A comparison of replacement and reconstruction in patients with mitral regurgitation. J Thorac Cardiovasc Surg 93:665–674
Arcidi JM, Hebeler RF, Craver JM, Jones EL, Hatcher CR, Guyton RA (1988) Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone. J Thorac Cardiovasc 95:951–959
Cohn LH (1985) Mitral valve surgery: reconstruction versus replacement. Z Kardiol [Suppl 6] 74:1–5
Cohn LH, Allred EN, Cohn LA, Austin JC, Sabik J, DiSesa VJ, Shemin RJ, Collins JJ (1985) Early and late risk of mitral valve replacement. J Thorac Cardiovasc 90:872–881
Cohn LH, Allred EN, Cohn LA, DiSesa VJ, Shemin RJ, Collins JJ Jr (1985) Long term results of open mitral valve reconstruction for mitral stenosis. Am J Cardiol 55:371–374
Cohn LH, Kowalker W, Bhatia S, DiSesa VJ, Shemin RJ, Collins JJ (1988) Comparative morbidity of mitral valve repair versus replacement for mitral regurgitation with and without coronary artery disease. Ann Thorac Surg 45:284–290
Connolly MW, Gelbfish MW, Jacobowitz IJ, Rose DM, Mendelsohn A, Cappabianca PM, Acinapura AJ, Cunningham JN (1986) Surgical results for mitral regurgitation from coronary artery disease. J Thorac Cardiovasc Surg 91:379–388
Czer LS, Gray RJ, DeRobertis MA, Bateman TM, Steward ME, Chaux A, Matloff JM (1984) Mitral valve replacement: impact of coronary artery disease and determinants of prognosis after revascularization. Circulation [Suppl I] 70:1–198
Davis TE, Uden PE, Straus HS (1983) The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation 68(III):71–82
DiSesa VJ, Cohn LH, Collins JJ Jr, Koster JK Jr, Van Devater SH (1982) Determinants of operative survival following combined mitral valve replacement and coronary revascularization. Ann Thorac Surg 34:482–489
Goldman ME, Mora F, Guarino T, Fuster V, Mindich BP (1987) Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function: an intraoperative two-dimensional echocardiography study. JACC 10:568–575
Goor AD, Mohr R, Lavee J, Serraf A, Smolinsky A (1988) Preservation of the posterior leaflet during mechanical valve replacement for ischemic mitral regurgitation and complete myocardial revascularization. J Thorac Cardiovasc Surg 96:253–260
Harold JG, Bateman TM, Czer LSC, Chaux A, Matloff JM, Gray RJ (1987) Mitral valve replacement early after myocardial infarction: attendant high risk of left ventricular rupture. JACC 9:277–282
Kay PH, Nunley DL, Grunkemeier GL, Pinson CW, Starr A (1985) Late results of combined mitral valve replacement and coronary bypass surgery. J Am Coll Cardiol 5:29–33
Lillehei CW, Levy MJ, Bonnabeau RC (1964) Mitral valve replacement with preservation of papillary muscles and chordae tendineae. J Thorac Cardiovasc Surg 47:532
Lytle BW, Cosgrove DM, Gill CC, Stewart RW, Golding LAR, Goormastic M, Taylor PC, Loop FD (1985) Mitral valve replacement combined with myocardial revascularization: early and late results for 300 patients, 1970 to 1983. Circulation 71:1179–1190
McGoon DC (1960) Repair of mitral insufficiency due to ruptured chordae tendinae. JTCVS 39:357–361
Magovern JA, Pennock JL, Campbell DB, Pierce WS, Waldhausen JA (1985) Risks of mitral valve replacement and mitral valve replacement with coronary artery bypass. Ann Thorac Surg 39:346–352
Rankin JS, Feneley MP, Hickey M SJ, Muhlbaier LH, Weschsler AS, Floyd RD, Reves JG, Skelton TN, Califf RM, Lowe JE, Sabiston DC (1988) A clinical comparison of mitral valve repair versus valve replacement in ischemic mitral regurgitation. J Thorac Cardiovasc Surg 95:165–177
Sand ME, Naftel DC, Blackstone EH, Kirklin JW, Karp RB (1987) A comparison of repair and replacement for mitral valve incompetence. J Thorac Cardiovasc Surg 94:208–219
Sarris GE, Cahill PD, Hansen DE, Derby GC, Miller DC, Händen CE, McConnel MV, Nic-zyporuk M, Williams CA (1988) Restoration of left ventricular systolic performance after reattachment of the mitral chordae tendineae. J Thorac Cardiovasc Surg 95:969–979
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1991 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Cohn, L.H. (1991). Surgical treatment of ischemic mitral regurgitation by repair and replacement. In: Vetter, H.O., Hetzer, R., Schmutzler, H. (eds) Ischemic Mitral Incompetence. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-662-08027-6_15
Download citation
DOI: https://doi.org/10.1007/978-3-662-08027-6_15
Publisher Name: Steinkopff, Heidelberg
Print ISBN: 978-3-662-08029-0
Online ISBN: 978-3-662-08027-6
eBook Packages: Springer Book Archive